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Dry Eye Syndrome Ocular Surface Disease DED/KCS/OSD Treatment with Scleral Prosthetic Lenses
What Is DED/KCS/OSD?
Some people do not produce enough tears or the appropriate quality of tears to keep the eye healthy and comfortable. This is known as Dry Eye Disease/Keratoconjunctivits sicca/Ocular Surface Disease (DED/KCS/OSD).
Tears are produced by two different methods. One method produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other method produces large quantities of tears in response to eye irritation or emotions. A healthy eye constantly produces tears that lubricate. Excessive tearing occurs when a foreign body, dryness, or other irritant challenges the eye or when a person cries for emotional reasons.
What Are the Symptoms of DED/KCS/OSD?
The usual symptoms include:
Stinging or burning eyes
Scratchiness
Stringy mucus in or around the eyes
Excessive eye irritation from smoke or wind
Excess tearing
Difficulty wearing contact lenses
Excess tearing from "DED" sounds illogical, but if the tears responsible for maintenance lubrication do not keep the eye wet enough, the eye becomes irritated. When the eye is irritated, the lacrimal gland produces a large volume of tears that overwhelm the tear drainage system. These excess tears then overflow from your eye.
What Is the Tear Film?
A film of tears, spread over the eye by a blink, makes the surface of the eye smooth and clear. Without our tear film, good vision would not be possible.
The tear film consists of three layers:
An oily layer
A watery layer
A layer of mucus
The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears. The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal gland, cleanses the eye and washes away foreign particles or irritants. The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.
What Causes DED/KCS/OSD?
Tear production normally decreases as we age. Although DED can occur in both men and women at any age, women are most often affected. This is especially true after menopause. DED also can be associated with other problems. For example, people with dry eye, dry mouth and rheumatoid arthritis are said to have Sjogren's syndrome. A wide variety of common medications — prescription and over-the-counter — can cause DED by reducing tear secretion. Be sure to tell your doctor the names of all the medications you are taking, especially if you are using:
Diuretics (High Blood Pressure, Heart Disease)
Beta-blockers (High Blood Pressure, Heart Disease)
Antihistamines (Allergy Medicine)
Sleeping pills
Medications for "nerves"
Pain relievers (Even OTC products like ibuprofen and naproxen
Since these medications are often necessary, the DED condition may have to be tolerated or treated with "artificial tears."
People with DED are often more prone to the toxic side effects of eye medications, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye. Special preservative-free artificial tears may be required.
How Is DED/KCS/OSD Diagnosed?
Your doctor is usually able to diagnose DED by examining the eyes. Sometimes tests that measure tear production may be necessary. One test, called the Schirmer tear test, involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. Another uses a diagnostic drop (fluorescein or rose bengal) to look for certain patterns of dryness on the surface of the eye.
How Is DED/KCS/OSD Treated?
Eye drops called artificial tears are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, (we recommend Systane or Endura) so you may want to try several to find the one you like best. Preservative-free eye drops are available if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you.
You can use the tears as often as necessary — once or twice a day or as often as several times an hour. Some people with DED complain of "scratchy eyes" when they wake up. Using an artificial tear ointment or thick eye drops at bedtime (such as Refresh P.M.) can effectively treat this symptom. Use the smallest amount of ointment necessary for comfort, since the ointment can cause your vision to blur.
Prescription Approaches
Newer prescription medications such as Restasis TM and Lotemax TM are very effective at treating moderate to severe DED. Ask your doctor which treatment is right for you.
Conserving the Tears
Conserving your eyes' own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel called a punctum into the nose (which is why your nose runs when you cry). Your physician may close these channels with silicone plugs. The closure conserves your own tears and makes artificial tears last longer.
Other Newer Technologies (Scleral Contacts)
Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heat is on, a humidifier or a pan of water on the radiator adds moisture to dry air. Wrap-around glasses may reduce the drying effect of the wind, but are illegal to wear while driving in some states. A person with DED should avoid anything that may cause dryness, such as an overly warm or cold room, hair dryers or wind. Smoking or being around a smoker can be especially especially bothersome due to the irritating particulates in the air. Another new options is a Scleral Contacts Prosthetic System. A scleral lens device is a transparent corneal prosthetic dome, filled with a sterile saline solution that serves as an artificial tear reservoir, providing constant lubrication to the eye, diluting inflamatory chemicals such as MMP-9 and others in the tear film that drive the inflammatory process in dry eye and helping to avoid lid sheer which is the friction induced by the eyelid rubbing on the dry surface of eye and allowing oxygen to reach the cornea. The device, about the size of a dime and composed of gas permeable material, creates a smooth surface over the damaged cornea and helps to heal the cornea by eliminating lid shear, which is the movement of the lid across the eye surface that in a dry eye can irritate the cornea because of the friction it causes. To learn more about scleral lenses for dry eye, visit our sister website.
To come for a FREE Scleral Lens Consutation for Dry Eye, call our facility today at 516.409.2020. Read below for more information on these incredible treatment options. The results can be life changing for the chronic, severe dry eye sufferer. Stop suffering. Call today!
